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Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JEAN CLAUDE DEMETRIUS M.D. (DIRECTOR)
(718) 393-3075
Entity
Organization

Contact information

Practice address
5515 VAN CLEEF ST, CORONA, NY 11368-3907
(718) 393-3075
(718) 393-3096
Mailing address
13876 QUEENS BLVD FL 1, BRIARWOOD, NY 11435-2930
(718) 850-6345
(718) 559-4895

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
208100000X
Physical Medicine & Rehabilitation Physician
Primary
2081N0008X
Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00951753
NY
Enumeration date
08/25/2008
Last updated
02/03/2009
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